REVIEW article
Front. Pediatr.
Sec. Pediatric Gastroenterology, Hepatology and Nutrition
Volume 13 - 2025 | doi: 10.3389/fped.2025.1675149
This article is part of the Research TopicApplication of Minimally Invasive Techniques in Gastrointestinal Diseases in ChildrenView all articles
Combined multichannel intraluminal impedance and pH (MII-pH) testing in infants and young children - a narrative review
Provisionally accepted
- 1Division of Neonatology, Nemours Children's Health, Orlando, Florida, United States
- 2Division of Gastroenterology, Nemours Children's Health, Wilmington, Delaware, United States
- 3Division of Neonatology, Christiana Care, Newark, Delaware, United States
- 4Nemours Children's Health at Thomas Jefferson University, Philadelphia, Pennsylvania, United States
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Gastroesophageal reflux disease (GERD) is common in infants and young children, and the diagnosis and characterization of the disease continues to evolve in recent times. The typical symptoms thought to be related to GERD in young children are often nonspecific and ubiquitous, underscoring the need for diagnostic testing in patients who have severe symptoms or complications related to GERD. Combined multichannel intraluminal impedance and pH testing (MII-pH) is a diagnostic tool that can be used to study the frequency and severity of gastroesophageal reflux. Compared to other diagnostic devices, MII-pH has the advantage of detecting both acidic and alkaline reflux events, as well as allows the study of the temporal association of symptoms with GER events. Using the diagnostic parameters defined and symptom association data obtained, MII-pH can then be used to classify patients as having GERD (with either predominantly acid or alkaline reflux), non-erosive reflux disease or NERD (when no evidence of esophagitis is noted on endoscopy), hypersensitive esophagus (positive symptom association only) and functional heartburn (normal study). The application of this disease classification to GERD in young children is relatively new and needs further validation. Even so, classifying GERD into these phenotypes using MII-pH allows for more precise and individualized therapeutic decisions. Emerging research has also suggested MII-pH testing can be used to predict changes in mucosal integrity and study the motility of the esophagus in children. Although the use of MII-pH in children with a large range of disease processes is becoming more widespread, there are important limitations to note in the interpretation of results of MII-pH in young children, due to the relative lack of normative data obtained from truly healthy children.
Keywords: Combined multichannel intraluminal impedance and pH testing, Gastroesophageal reflux - diagnosis, Treatment, GERD in children, GERD symptoms in children, GERD phenotypes
Received: 29 Jul 2025; Accepted: 15 Sep 2025.
Copyright: © 2025 Sequeira Gomes, Abraham, Favara and Aghai. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Rochelle Sequeira Gomes, rochelle.sequeiragomes@nemours.org
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.